Purposeful Parent Questionnaire

Hi, I am excited for your interest in becoming a purposeful parent! In order to be the best parent you can be, you must first SEE yourself. Please send me your Birthday, Birth place and Birth time. (if you don’t know the exact time, try to find out if you were born early morning, mid day or nighttime.)

The Family School of Thought

* Name

* Email Address

* Phone

* Your Birthdate

* Time of Birth

* Place of Birth

* What is your biggest struggle in your home right now?

* Child you wish to focus on-name and age

* How many children are in the home?

* What do you hope to get out of coaching with me?

* On a scale of 1-4 where do you see your current relationship with your child? (click here to view choices)

* On a scale of 1-4 where do you see your child’s ability to thrive? (click here to view choices)

Is there any other situations occurring in your home that are causing you to also seek help?

What means success for you in family life?

Are you ready to have that success in your life right now?

13 + 8 =